Individual
STACEY LYNN TISSUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLBSW
Contact information
Practice address
2875 HENRY ST, PORT HURON, MI 48060-2526
(810) 987-9700
Mailing address
4090 WELLMAN LINE RD, JEDDO, MI 48032-8105
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6802086138
MI
Other
Enumeration date
04/01/2008
Last updated
04/01/2008
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